Perleche

Angular chelitis is a relatively common conditon affecting the oral commissures, or the creases where the upper and lower lip edges meet. There are several factors that lead to its development. These include the formation of deep furrowed creases at the edges of the mouth in older individuals, collection of saliva from drooling, and superinfection of various pathogens. These can include yeast such as candida, bacteria such as staphylococcus aureas, and herpesviruses.

Differential diagnosis:
-Lip licking dermatitis
-Nutritional deficiency
-Orolabial HSV
-Contact dermatitis

Diagnosis:
-Usually made on clinical grounds but occasionally culture for microorganisms is helpful

Treatment:
-Once bacterial superinfection has been treated or ruled out, a combination of a low potency topical steroid in conjunction with a topical antifungal is helpful; in severe or recalcitrant cases a dermal filler can be used to alter the shape of the oral commissures, preventing buildup and trapping of saliva.